HIV/AIDS Newsroom: September 7, 2000

Recent developments in tuberculosis (TB) research have led to potential new therapies. The sequencing of Mycobacterium tuberculosis is the first step towards treatment progress. Normally treated with four drugs, TB can remain latent for years, needing extensive months of drug therapy to kill remaining bacteria. Directly observed treatment, short-course (DOTS), involves watching patients take their pills for six to eight months, ensuring adherence to the regimen. The Global Alliance for TB Drug Development aims to create a drug that more quickly kills any slow-growing bacteria that survives the four-drug cocktail. The goal is to reduce the treatment time to two months or below. Researchers believe that slow-growing M. tuberculosis could be targeted to create a way to eradicate the bacteria in asymptomatic individuals with TB. Mike Wilson of Affymax Research Institute in Santa Clara, California, is working with the National Institute of Allergy and Infectious Diseases to screen candidate drugs through gene expression patterns. Latent TB continues to pose hurdles to researchers who do not know whether the bacteria are dormant or are actively replicating and controlled by the immune system. There are several hypotheses, one being that bacteria hide inside macrophages, which ingest foreign microorganisms.

Advances in drug treatment have helped an increasing number of HIV-infected individuals to return to work. There are an estimated 800,000 to 900,000 people in the United States living with HIV, and data from the Centers for Disease Control and Prevention show that about 40,000 new HIV infections occur in the country each year. Employers must struggle with maintaining employees' confidentiality regarding HIV, often fighting stigmas within the office. U.S. companies that do business abroad are also being forced to confront the epidemic. For example, Coca-Cola is considering holding AIDS education programs for its workers in South Africa, while Ford Motor offers education and male and female condoms at its two plants in the country. In the United States, workers with HIV have filed many complaints based on laws against discrimination. Over 2,100 complaints claiming discrimination related to HIV were filed with the Equal Employment Opportunity Commission between 1992 and 1999. As a result, a number of companies are taking steps to educate their workers. Home Depot, for instance, provides pamphlets on AIDS to its workers and spends nearly $20,000 to educate its store managers about the disease. But many companies do little to increase benefits or teach its workers. A survey by the National AIDS Fund shows that nearly three-quarters of working Americans would like AIDS education in the workplace, although only 18 percent say their employers provide such information. Starting today, the CDC is hosting a two-day conference in Washington, D.C., on ways to deal with HIV and AIDS in the workplace. Participants will include Health and Human Services Secretary Donna Shalala and AFL-CIO President John Sweeney.

AIDS treatments in Russia are scarce, and Moscow's only AIDS center is a crumbling building. Russia's AIDS epidemic, fueled by intravenous drug abuse and promiscuity, could reach over 1 million people by early next year, according to experts. As of August, Russia had reports of over 52,400 HIV infections;
however, many cases are not recorded because patients never seek official treatment. Oleg Yurin, head of clinical research at the Russia AIDS Center, stated, "In general, the government is totally underestimating the problem." The country has had
extensive HIV testing programs since the late 1980s, but treatment is hard to find and afford. The Russia AIDS Center has no beds, and Yurin notes that about 400 people in Moscow receive treatment, although few take combination drug regimens.

The Board of Health in Allegheny County, Pennsylvania, has decided to postpone action on making HIV a reportable disease, in order to ensure patient privacy is protected. So far, 28 states require hospitals and doctors to report HIV cases to health agencies; Pennsylvania requires only AIDS cases to be reported. The proposed regulation would let healthcare providers decide to report HIV cases by name or code. However, one board member asserted that patients should be the ones to decide how their cases are reported. In addition, some AIDS activists expressed concern that reporting HIV cases could lead to avoidance of testing. Dr. Bruce Dixon, the county's health director, said the document of the infection will remain confidential, even within the health department, and he explained the surveillance will help track the epidemic and better identify those at risk.

A solar-powered Danish invention that involves pasteurizing HIV-infected breast milk at 60 degree Celsius for 30 minutes can inactivate HIV and bacteria, possibly providing an affordable solution for fighting HIV in developing countries. The annual cost per child would be about $100, according to Dr. Anders Fjendbo Jorgensen of Kolding Hospital in Denmark. The pasteurization retains the antibodies in breast milk, and Dr. Jorgensen hopes the device will soon be used in Africa and Asia. Dr. Jorgensen, who has been working the National AIDS Control Program in Tanzania for three years, believes that the device might also be used to purify water.

An editorial in the Deseret News points out that, contrary to what many Americans believe, tuberculosis (TB) is not a distant memory and takes the lives of millions of people every year. The Centers for Disease Control and Prevention estimates that one-third of the world is infected with at least a latent form of TB, including 10 million to 15 million Americans. Over 17,500 new TB cases were recorded in the United States last year. The editorial notes the need for new drug therapies to help eradicate TB, particularly as drug-resistant strains appear. According to the editorial, "Congress needs to recognize that TB, while primarily a scourge in underdeveloped countries, is a threat to this nation as well. Lawmakers should dedicate themselves to eliminating it once and for all."

The District of Columbia's $4.9 billion fiscal year 2001 budget is set to go before the House of Representatives today, and a private needle exchange program in the city may be a cause for debate. One Kansas Republican is expected to introduce an amendment prohibiting a private, nonprofit clinic from handing out needles within 1,000 feet of schools, pools, parks, public housing, and daycare areas in the city. Critics of the amendment believe it could kill the needle exchange.

African leaders at the U.N. Millennium Summit in New York discussed poverty, HIV/AIDS, and conflicts in their continent, asking for global help. South African President Thabo Mbeki stated that developed countries seem more willing to help Africa, but he called on Africans to also contribute more to ending problems at home. Namibia's president, Sam Nujoma, noted the toll the AIDS epidemic was taking on Africa, and he urged pharmaceutical companies to help make cheaper AIDS drugs available. He also discussed the need for political, corporate, and religious cooperation to halt the epidemic.

As HIV continues to affect more Hispanics in the United States, one Chicago researcher has started a new prevention campaign aimed at Hispanic women. Dr. Nilda Peragallo, an associate professor at the College of Nursing in the University of Illinois at Chicago, hopes to reduce the number of Hispanic women become infected with HIV. Funding from the National Institutes of Health and National Institute of Nursing Research helped set up the three-year study that includes a tailored intervention program for over 750 women in Chicago's Hispanic communities. Peragallo said that focus groups in the community helped identify problems with accepting HIV prevention, areas of most interest, and what women would want from an intervention. The interventions are then held once a week for six weeks for groups of eight to 12 women with a bilingual and Hispanic facilitator nurse. The first four sessions focus on discussing women's bodies, HIV and other sexually transmitted diseases in the women's communities, condoms, and communication techniques for women to use with their partners. The women also learn to release tension and downplay conflict they may be feeling, learning how to prevent violence so they can negotiate condom use. The sixth session involves a review of the previous meetings, and a "booster" session is offered three months later. The booster sessions also provide the women with an opportunity to give feedback on the project. While results of the pilot program have not yet been published, early data from 347 baseline interviews indicate that women who have with a history of violence in their relationships are at greater risk for having low self-esteem and depression and are at high risk for infection with HIV.

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